Risk profile of Qatari women treated for infertility, 2018

doi:10.21203/rs.2.20724/v1

Background: female infertility is a multifactorial condition constituting a worldwide public health problem. Although many potential risk factors of female infertility can be preventable, there is no much attention directed toward preconception care.

Aim: to explore the risk profile of infertility among Qatari women and compare risk factors distribution among primary vs. secondary infertility.

Methodology: A hospital-based case control study was conducted from September 17th, 2017- February 10th, 2018. Cases (n=136) were enrolled from infertility clinics and controls (pregnant women, n=272), were enrolled from antenatal clinic, Women Hospital, Hamad Medical Corporation. Interview questionnaire was utilized to collect data about sociodemographic, history of marriage, lifestyle, menstrual, obstetric, gynaecological, medical, medication, surgical, birth-control, sexual and family, depression screening using PHQ-2 score, and anthropometric measurements. Logistic regression was used to identify the associated factors to infertility. Statistical significance was set at 0.05.

Results: 43 primary and 93 secondary infertility cases were included. Risk factors were age>35 years (OR=3.7), second-hand smoking (OR=2.44), steady weight gain (OR=4.65), recent weight gain (OR=4.87), menstrual cycle irregularities (OR=4.20), fallopian tube blockage (OR=5.45), and symptoms suggestive of sexually transmitted infections (STIs) including chronic lower abdominal/pelvic pain (OR=3.46), abnormal vaginal discharge (OR=3.32) and dyspareunia (OR=7.04). Predictive factors for secondary infertility were; longer time from previous conception (OR=5.8), history of stillbirth (OR=2.63) or miscarriage (OR=2.11) and postpartum infection (OR=3.75). Protective factors were higher education level (OR=0.44), higher income (OR=0.17), and awareness of fertility window (OR=0.33)

Conclusion: awareness, prevention, and early management of modifiable risk factors is important for women at pre/post-conception periods.

Sexual & Reproductive Medicine

primary infertility

secondary infertility

Qatar

risk profile

Table (1): Distribution of study participants according to their socio-demographic characteristics, Women Hospital-Hamad Medical Corporation, 2018

Sociodemographic

Cases

Controls

p value

Primary Infertility

n = 43 (%)

Secondary Infertility

n = 93 (%)

Infertility Total

n = 136 (%)

n = 272(%)

Age group:

16 - 25 year
26 - 35 year
> 35 year

Mean + SD

12 (27.9)

23 (53.5)

8 (18.6)

29.4 + 6.7

12 (12.9)

43 (46.2)

38 (40.9)

33.9 + 6.0

24 (17.7)

66 (48.5)

46 (33.8)

32.5 + 6.6

59 (21.7)

164(60.3)

49 (18.0)

30.2 + 5.5

0.002*

Educational level:

Illiterate
Primary
Preparatory
Secondary
University / higher

1 (2.3)

6 (14.0)

1 (2.3)

17 (39.5)

18 (41.9)

5 (5.4)

4 (4.3)

11 (11.8)

40 (43.0)

33 (35.5)

6 (4.4)

10 (7.4)

12 (8.8)

57 (41.9)

51 (37.5)

2 (0.7)

13 (4.8)

131(48.2)

113(41.5)

0.028*

Average household monthly income:

< 12.000 QR
12.000-<25.000 QR
> 25.000 QR

5 (11.6)

13 (30.2)

25 (58.1)

6 (6.5)

33 (35.5)

54 (58.1)

11 (8.1)

46 (33.8)

79 (58.1)

5 (1.8)

52 (19.1)

215(79.0)

0.001*

Age at first marriage:

< 20 years
20 - < 25
25 - < 30
30 - <35
> 35

Mean + SD

6(14.0)

18(41.9)

10(23.3)

4(9.3)

5(11.6)

25.8 + 6.8

26(28.0)

37(39.8)

23(24.7)

5(5.4)

2(2.2)

22.7 + 4.6

32(23.5)

55(40.4)

33(24.3)

9(6.6)

7(5.1)

23.7 +5.6

86(31.6)

113(41.5)

59(21.7)

12(4.4)

2(0.7)

22.1 + 4.4

0.024*

Husband’s absence:

Never been absent
Yes, occasionally
Yes, frequently/seasonally
Yes, most of the time
Yes, "collectively"

33 (76.7)

4 (9.3)

2 (4.7)

10(23.3)

60 (64.5)

17 (18.3)

12 (12.9)

4 (4.3)

33 (35.5)

93 (68.4)

21 (15.4)

16 (11.8)

6 (4.4)

43 (31.6)

232 (85.3)

19 (7.0)

16 (5.9)

5 (1.8)

40 (14.7)

0.001*

* p < 0.05

SD: Standard Deviation, QR: Qatari Riyals

Table (2): Distribution of study participants according to their lifestyle-related characteristics, Women Hospital-Hamad Medical Corporation, 2018

Lifestyle history

Cases

Controls

p value

Primary Infertility

n = 43 (%)

Secondary Infertility

n = 93 (%)

Infertility Total

n =136 (%)

n = 272 (%)

Water pipe smoking:

- No

- Yes, currently

- Yes, previously

- Yes, "collectively"

41 (95.3)

1 (2.3)

2 (4.7)

86 (92.5)

5 (5.4)

2 (2.2)

7 (7.5)

127 (93.4)

6 (4.4)

3 (2.2)

9 (6.6)

268 (98.5)

3 (1.1)

1 (0.4)

4 (1.5)

0.005*

Second hand smoking:

- No

- Yes, currently

- Yes, previously

- Yes, "collectively"

15 (35.9)

17 (39.5)

11 (25.6)

28 (65.1)

42 (45.2)

41 (44.1)

10 (10.8)

51(54.8)

57 (42.0)

58 (42.6)

21 (15.4)

79 (58.1)

153 (56.3)

103 (37.9)

16 (5.9)

119 (43.8)

0.006*

Vigorous exercise:

- No

- Yes

40 (93.0)

3 (7.0)

84 (90.3)

9 (9.7)

124 (91.2)

12 (8.8)

263 (96.7)

9 (3.3)

0.017*

Childhood obesity:

- No

- Yes

34 (79.1)

9 (20.9)

70 (75.3)

23 (24.7)

104 (76.5)

32 (23.5)

238 (87.5)

34 (12.5)

0.004*

Steady weight gain since marriage:

- No

- Yes

11 (25.6)

32 (74.4)

25 (26.9)

68 (73.1)

36 (26.5)

100 (73.5)

203 (74.6)

69 (25.4)

0.001*

Recent weight gain:

- No

- Yes

15 (34.9)

28 (65.1)

38 (40.9)

55 (59.1)

53 (39.0)

83 (61.0)

232 (85.3)

40 (14.7)

0.001*

* p < 0.05

Table (3): Distribution of study participants according to gynaecological history, Women Hospital-Hamad Medical Corporation, 2018

Gynecological history

Cases

Controls

P value

Primary Infertility

n = 43 (%)

Secondary Infertility

n = 93 (%)

Infertility Total

n =136 (%)

n = 272 (%)

Menstrual cycle regularity:

- Regular

- Irregular

32 (74.4)

11 (25.6)

65 (69.9)

28 (30.1)

97 (71.3)

39 (28.7)

256 (94.1)

16 (5.9)

0.001*

Menstrual irregularity:

- < 6 month

- ≥ 6 month

n = 11

1 (9.1)

10 (90.9)

n = 28

4 (14.3)

24 (85.7)

n = 39

5 (12.8)

34 (87.2)

n = 16

8 (50.0)

0.001*

Duration of menstrual cycle:

- < 21 days

- 21 - 35 days

- > 35 days

0 (0.0)

33 (76.7)

10 (23.3)

1 (1.1)

61 (65.6)

31 (33.3)

1 (0.7)

94 (69.1)

41 (30.2)

0 (0.0)

252 (92.6)

20 (7.4)

0.001*

Menorrhagia:

- No

- Yes

31 (72.1)

12 (27.9)

72 (77.4)

21 (22.6)

103 (75.7)

33 (24.3)

260 (95.6)

12 (4.4)

0.001*

Intermenstrual bleeding:

- No

- Yes

38 (88.4)

5 (11.6)

84 (90.3)

9 (9.7)

122 (89.7)

14 (10.3)

272(100.0)

0 (0.0)

0.001*

Dysmenorrhoea:

- No

- Yes

30 (69.8)

13 (30.2)

74 (79.6)

19 (20.4)

104 (76.5)

32 (23.5)

256 (94.1)

16 (5.9)

0.001*

Secondary amenorrhea:

- No

- Yes

31 (72.1)

12 (27.9)

67 (72.0)

26 (28.0)

98 (72.1)

38 (27.9)

258 (94.9)

14 (5.1)

0.001*

Chronic pelvic pain

- No

- Yes

27 (62.8)

16 (37.2)

52 (55.9)

41 (44.1)

79 (58.1)

57 (41.9)

255 (93.8)

17 (6.2)

0.001*

Abnormal vaginal discharge:

- No

- Yes

36 (83.7)

7 (16.3)

64 (68.8)

29 (31.2)

100 (73.5)

36 (26.5)

261 (96.0)

11(4.0)

0.001*

Painful urination:

- No

- Yes

38 (88.4)

5(11.6)

80 (86.0)

13(14.0)

118 (86.8)

18 (13.2)

269 (98.9)

3 (1.1)

0.001*

Dyspareunia:

- No

- Yes

25 (58.1)

18 (41.9)

55 (59.1)

38 (40.9)

80 (58.8)

56 (41.2)

262 (96.3)

10 (3.7)

0.001*

* p < 0.05

Table (4): Distribution of secondary infertility participants and controls according to their obstetric history, Women Hospital-Hamad Medical Corporation, 2018

Obstetric history

Secondary infertility

n = 93 (%)

Controls

n = 272 (%)

p value

Previous conception:

- No

- Yes

0 (0.0)

93 (100.0)

42 (15.4)

230 (84.6)

0.001*

Time from previous conception:

- < 5 years

- 5 - <10 years

- 10 - <15 years

- ≥ 15 years

n = 93

47 (50.5)

38 (40.9)

4 (4.3)

n = 230

194 (84.3)

32 (14.0)

4 (1.7)

0 (0.0)

0.001*

Outcome of previous conception:

- Stillbirth

Never
Happened once or more

- Miscarriage

Never
Once
Twice or more

80 (86.0)

13 (14.0)

35 (37.6)

23 (24.8)

n = 230

219 (95.2)

11 (4.8)

124 (53.9)

57 (24.8)

49 (21.3)

0.004*

0.021*

Post-partum / post-abortal infection:

- No

- Yes

83 (89.2)

10 (10.8)

n = 230

223 (97.0)

7 (3.0)

0.005*

Caesarean section:

- No

- Yes

55 (59.1)

38 (40.9)

192 (70.6)

80 (29.4)

0.042*

* p < 0.05

Table (5): Distribution of study participants according medical/medication history, Women Hospital-Hamad Medical Corporation, 2018

Medical/ Medication history

Cases

Controls

p value

Primary Infertility

n = 43 (%)

Secondary Infertility

n = 93 (%)

Infertility Total

n =136 (%)

n = 272 (%)

Hypothyroidism:

- No

- Yes

35 (81.4)

8 (18.6)

75 (80.6)

18 (19.4)

110 (80.9)

26 (19.1)

242 (89.0)

30 (11.0)

0.025*

Hyperprolactinemia:

- No

- Yes

34 (79.1)

9 (20.9)

78 (83.9)

15 (16.1)

112 (82.4)

24 (17.6)

255 (93.8)

17 (6.2)

0.001*

Depression and/or other psychological disorders:

- No

- Yes

40 (93.0)

3 (7.0)

88 (94.6)

5 (5.4)

128 (94.1)

8 (5.9)

270 (99.3)

2 (0.7)

0.002*

Polycystic ovarian syndrome:

- No

- Yes

21 (48.8)

22 (51.2)

43 (46.2)

50 (53.8)

64 (47.1)

72 (52.9)

220 (80.9)

52 (19.1)

0.001*

Fibroid uterus:

- No

- Yes

37 (86.0)

6 (14.0)

86 (92.5)

7 (7.5)

123 (90.4)

13 (19.6)

261 (96.0)

11 (4.0)

0.026*

Appendectomy

- No

- Yes

41 (95.3)

2 (4.7)

84 (94.3)

9 (9.7)

125 (91.9)

11 (8.3)

263 (96.7)

9 (3.3)

0.035*

Prolonged steroid:

- No

- Yes

42 (97.7)

1 (2.3)

84 (90.3)

9 (9.7)

126(92.6)

10 (7.4)

267 (98.2)

5 (1.8)

0.050*

Hormonal therapy:

- No

- Yes

15 (34.9)

28 (65.1)

19 (20.4)

74 (79.6)

34 (25.0)

102(75.0)

260 (95.6)

12 (4.4)

0.001*

Prolonged high dose of NSAID:

- No

- Yes

40 (93.0)

3 (7.0)

78 (83.9)

15 (16.1)

118(86.8)

18 (13.2)

261 (96.0)

11 (4.0)

0.001*

Anti-obesity

(Xenical^®, Meridia^®):

- No

- Yes

42 (97.7)

1 (2.3)

81 (87.1)

12 (12.9)

123(90.4)

13 (9.6)

267 (98.2)

5 (1.8)

0.001*

* p < 0.05

NSAID: Non-Steroidal Anti Inflammatory Drugs

Xenical^® is the trade name for Orlistat, Meridia^® is the trade name for Sibutranine

Table (6): Distribution of study participants according medical/medication history, Women Hospital-Hamad Medical Corporation, 2018

Birth -control/ sexual history

Cases

Controls

p value

Primary Infertility

n = 43 (%)

Secondary Infertility

n = 93 (%)

Infertility Total

n =136 (%)

n = 272 (%)

Previous postpone of child bearing:

- No

- Yes

38 (88.4)

5 (11.6)

45 (48.4)

48 (51.6)

83 (61.0)

53 (39.0)

88 (32.4)

184 (67.6)

0.001*

Hormonal control:

- No

- Yes

n = 5

2 (40.0)

3 (60.0)

n = 48

13 (27.1)

35 (72.9)

n = 53

15 (28.3)

38 (71.7)

n = 184

92 (50.0)

0.006*

Birth control through natural / barrier methods:

- No

- Yes

n = 5

3 (60.0)

2 (40.0)

n = 48

39 (81.2)

9 (18.8)

n = 53

42 (79.2)

11 (20.8)

n = 184

106 (57.6)

78 (42.4)

0.004*

Awareness about fertility window:

- No

- Yes

18 (41.9)

25 (58.1)

38 (40.9)

55 (59.1)

56 (41.2)

80 (58.8)

51 (18.8)

221 (81.2)

0.001*

Loyalty to fertility window:

- No

- Yes

24 (55.8)

19 (44.2)

51 (54.8)

42 (45.2)

75 (55.1)

61 (44.9)

71 (26.1)

201 (73.9)

0.001*

* p < 0.05

Table (7): Distribution of study participants according to their family history, Women Hospital-Hamad Medical Corporation, 2018

Family history

Cases

Controls

p value

Primary Infertility

n = 43 (%)

Secondary Infertility

n = 93 (%)

Infertility Total

n =136 (%)

n = 272 (%)

Female infertility:

- No

- Yes

24 (55.8)

19 (44.2)

55 (59.1)

38 (40.9)

79 (58.1)

57 (41.9)

197 (72.4)

75 (27.6)

0.004*

Menstrual cycle irregularity:

- No

- Yes

28 (65.1)

15 (34.9)

63 (67.7)

30 (32.3)

91 (66.9)

45 (33.1)

227 (83.5)

45 (16.5)

0.001*

Polycystic ovarian syndrome:

- No

- Yes

30 (69.8)

13 (30.2)

69 (74.2)

24 (25.8)

99 (72.8)

37 (27.2)

221 (81.3)

51 (18.8)

0.050*

Fibroid:

- No

- Yes

34 (79.1)

9 (20.9)

75 (80.6)

18 (19.4)

109 (80.1)

27 (19.9)

246 (90.4)

26 (9.6)

0.004*

Diabetes mellitus:

- No

- Yes

16 (37.2)

27 (62.8)

35 (37.6)

58 (62.4)

51 (37.5)

85 (62.5)

197 (72.4)

75 (27.6)

0.001*

Thyroid disease:

- No

- Yes

30 (69.8)

13 (30.2)

55 (59.1)

38 (40.9)

85 (62.5)

51 (37.5)

219 (80.5)

53 (19.5)

0.001*

* p < 0.05

Table (8): Distribution of study participants according to their WHO-BMI classification/ PHQ-2 score, Women Hospital-Hamad Medical Corporation, 2018

WHO-BMI classification	Cases		Cases	Controls	p value
WHO-BMI classification	Primary Infertility n = 43 (%)	Secondary Infertility n = 93 (%)	Infertility Total n =136 (%)	n = 272 (%)	p value
Underweight	0 (0.0)	0 (0.0)	0 (0.0)	7 (2.6)	0.002*
Normal weight	6 (13.9)	15 (16.1)	21 (15.4)	68 (25.0)
Overweight	14 (32.6)	27 (29.0)	41 (30.2)	98 (36.0)
Obese	23 (53.5)	51 (54.9)	74 (54.4)	99 (36.4)
Mean BMI + SD	30.9 + 6.2	31.6 + 6.6	31.4 + 6.4	28.7 + 6.1	0.001*
PHQ-2 score result: - Negative - Positive	38 (88.4) 5 (11.6)	79 (84.9) 14 (15.1)	117 (86.0) 19 (14.0)	257 (94.5) 15 (5.5)	0.004*

* p < 0.05

Table (9): Infertility risk factors: Results of the multivariate logistic regression analysis, Women Hospital-Hamad Medical Corporation, 2018

Independent risk factors	Adjusted odds ratio (aOR)	p-value	95% Confidence interval (CI)
Model I: Independent risk factors of infertility
Age of participants (> 35 years)	3.72	0.008*	1.41 - 9.83
Second hand smoking	2.44	0.008*	1.26 - 4.73
Steady weight gain since marriage	4.65	0.001*	2.43 - 8.91
Recent weight gain	4.87	0.001*	2.54 - 9.32
Menstrual cycle irregularity	4.20	0.031*	1.14 - 15.49
Sexually transmitted infections (STIs) suggestive symptoms: Lower abdominal / pelvic dull pain Abnormal vaginal discharge Dyspareunia	3.46 3.32 7.04	0.002* 0.019* 0.001*	1.57 - 7.63 1.22 - 9.03 2.76 - 17.95
Fallopian tube blockage	5.45	0.003*	1.75 - 16.95
Model II: Independent risk factors of secondary infertility**
Time from last conception ≥5 years	5.8	0.001*	3.28 - 10.21
History of stillbirth (once or more)	2.63	0.042*	1.04 - 6.67
Miscarriage (once or more)	2.11	0.008*	1.21 - 3.68
Post-partum / Post-abortal infection	3.75	0.016*	1.27 - 11.06

* p < 0.05

** Model II included comparison between secondary infertile women (n = 93) and controls who reported previous conception (n = 230)

Risk profile of Qatari women treated for infertility, 2018

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